Abstract
Objective: To report safety and efficacy of interventional radiology procedures in the treatment of gynecologic iatrogenic urinary leaks. Methods: A retrospective analysis of iatrogenic ureteral lesions treated between November 2009 to April 2019 was performed. Under ultrasound (US) and fluoroscopy guidance, an attempt to place a ureteral stent and nephrostomy was carried out in the same session using an anterograde percutaneous approach. At the end of any procedure, a fluoroscopic control and a cone-beam CT scan (CBCT) were performed to check the correct placement and functioning of the nephrostomy and DJ stent. In cases of difficult ureteral stent placement via the single anterograde approach, the collaboration of urologists was requested to perform a rendezvous technique, combined with the retrograde approach. Results: DJ stent placement was achieved using the anterograde approach in 12/15 (80.0%) patients and using the retrograde approach in 3/15 cases (20.0%). Moreover, in 3/15 (20.0%) patients, surgical treatment was needed: in one case because of the persistence of ureteral stenosis at 6 months, and in the other two cases due to ureter-vaginal fistula. No major complications were recorded; overall, minor complications occurred in 4/8 patients. Conclusion: Percutaneous minimally invasive treatment of iatrogenic ureteral lesions after gynecological surgery is a safe and effective option.
Highlights
Extremely rare, iatrogenic ureteral injuries are a severe complication of gynecological surgery [1]
The purpose of this study is to report the safety and efficacy of interventional radiology procedures in the treatment of iatrogenic urinary leaks in different types of ureteral lesions in gynecologic surgery
All complications were recorded and classified as minor and major according to Common Terminology Criteria for Adverse Events (CTCAE), Version 4.0 [13]
Summary
Iatrogenic ureteral injuries are a severe complication of gynecological surgery [1]. The risk of damage increases when the normal anatomy is altered by primary pathologic factors, by pelvic adhesions, or when the ureter is poorly recognizable because of intraoperative complications, such as severe bleeding [2]. Urinary tract injuries occur in 0.2%–1% of all gynecologic pelvic surgeries, with higher risk reported in case of severe endometriosis and locally advanced cervical cancers [3]. Uterine arteries cross the ureters anteriorly, with higher risk of iatrogenic injury during hysterectomy, ranging from 1% in in laparoscopic approach for benign disease, to 10.7% in open surgery for cervical malignancy. Injuries occur most frequently in the lower third of the ureter (51%), and less frequently in the upper and middle third (30% and 19%, respectively) [4]. Injuries can occur by ligation or kinking by a ligature, by clamping, division, devascularization, or diathermy-related injury; the most common injury mechanism is complete or partial transection [5,6]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
